Rare case of high amylase pleural effusion without pancreatitis, oesophageal rupture or malignancy.

High amylase pleural effusion remains an entity which includes a wide variety of differentials, with pancreatitis, oesophageal rupture or malignant pleural effusion being most commonly encountered in clinical practice. Keeping the clinical picture (suggestive of pain in abdomen preceding any respiratory complaints) and differentials at hand, the case was evaluated with contrast-enhanced CT of the thorax and abdomen which revealed normal pancreatic architecture and no abnormal communication was noted between the pancreas and pleural space. A contrast oesophagogram, done when pancreatitis was ruled out, showed no evidence of any leak. The patient underwent upper gastrointestinal endoscopy which was suggestive of an ulcer with fistulous communication with the pleural space. Following nasojejunal feeding and clipping of the fistulous tract the patient's symptoms improved.

Chemotherapy Associated Bilateral Secondary Spontaneous Pneumothorax.

Chemotherapy-associated pneumothorax is a rarely encountered oncological emergency. Herein, we present a rare chemotherapy-associated bilateral secondary spontaneous pneumothorax case of a man in his 60s with invasive breast carcinoma after four cycles of chemotherapy. He presented to our emergency department with acute onset dyspnea and left-sided pleuritic chest pain. A chest X-ray showed a left-sided pneumothorax, and an intercostal chest tube (ICT) was inserted with underwater seal drainage. After three days, he complained of sudden onset right-sided chest pain and increased dyspnea. A repeat chest X-ray revealed right-sided pneumothorax, which was managed with ICT again. Bilateral pleurodesis was done after a repeat chest x-ray showed complete lung re-expansion. The patient was doing well with no recurrence of pneumothorax after three months of follow-up. Male breast cancer is uncommon, and presentation with bilateral secondary spontaneous pneumothorax is rare. This case is reported as a rare complication of chemotherapy-associated bilateral spontaneous pneumothorax.